The Local Health Department DHS 140 Review Process Tim Ringhand DHS – Division of Public Health November 15, 2013 The Local Health Department DHS 140 Review Process New Health Officer Orientation November 15, 2013 Tim Ringhand, Regional Director Western Region Division of Public Health

Statutory and Administrative Rule 140 Review History 1993 Public Health Statutes revised to say: WI statute 251.20 (1) Rule making. The department shall promulgate rules that specify all of the following: (1) Required services for each of Levels I, II and III local health departments under s. 251.05 (2). (2) Additional required services for Level II and Level III local health departments under s. 251.05 (2) (b) and (c), including services that the department of health services determines appropriately address objectives or services specified in the most recent public health agenda under s. 250.07 (1) (a).

Statutory and Administrative Rule 140 Review History Chapter DHS 140 - REQUIRED SERVICES OF LOCAL HEALTH DEPARTMENTS DHS 140.07 Designation of level of local health department. (1) Under the authority of s. 251.20 (1), Stats., the department shall direct a process to formally review the operations of all local health departments in a county or municipality at least every 5 years. A review of the operations of a local health department shall result in a written finding issued by the state health officer as to whether the local health department satisfies the requirements for a level I, II or III local health department. (2) In directing the review under sub. (1), the state health officer shall use department personnel and other appropriate local health officials who have expertise in the field of public health and are knowledgeable about the requirements for local health departments.

140 Review History 140 reviews began in 1999 with the 140 review of all city and county health departments (HD). 140 review tools were developed that addressed various health department organizational styles: City HD County HD City/County HD Health and Human Service HD

140 Review History The 1999 140 tool also addressed the various Level of health departments. Level I, II, III criteria; and Incorporated Healthier People in Wisconsin – A Public Health Agenda for the Year 2000 (HW 2000) as our defining document.

2005 – 140 Review History Next five year 140 review cycle tool place in 2005. Major changes from the 1999 140 review process were: Used Healthiest Wisconsin 2010 (not HW 2000) as the standard. Reduced redundancy of similar questions/evidence during the 140 review process. Central Office/Regional Office team reviewed but did not collect evidence. Replaced the three main areas of the 1999 review (Board of Health (BOH), Health Officer (HO), Local Health Department (LHD)) with the “Twelve Essential PH Services” and placed specific questions under the specific Essential Service.

2005 – 140 Review History Major changes from the 1999 140 review process: Created a separate justification document for Level II and Level III LHDs. Used “Health Priorities” as a means to determine Level II or Level III status. Level II: Seven programs or services that address at least five health priorities of the current state health plan (Healthiest Wisconsin 2010). Level III: Fourteen programs or services that address at least seven health priorities of the current state health plan (Healthiest Wisconsin 2010).

2005 – 140 Review History Level III agency Agent of the state for the Hotel and Restaurant program. Agent of the state for the Tattoo and Body Piercing program. Health Officer with a master’s degree in public health, public administration, or similar field and three years of full time administrative experience in a public health agency or public health work. Bachelor’s of science and sixteen graduate credits toward a degree in public health, public or health administration, and five years of experience in a full time administrative position in a public health agency or public health work.

2009 – 140 Review History 2009 was the last major 140 review of all LHDs by DPH. Healthy Wisconsin 2010 still used as the resource. LHDs filled out 140 review electronic survey form. LHDs e-mailed the completed survey form to their respective regional office.

140 Review History – Lessons Learned 1. Simplify the review process where possible. Combine related statutes Eliminate redundant evidence requests Utilize evidence already provided to DPH 2. Use electronic document collection systems when possible. 3. Improve DHS 140 on-site visit so that it provides support for LHD operations. 4. Include changes in national standards such as the Public Health Accreditation Board (PHAB).

2014 140 Review Guiding Principles Assure LHD statutory compliance with requirements to provide a basic level of services for all citizens; Efficiently collect only evidence essential to meeting statutory requirements; Support PHAB accreditation readiness for non- PHAB accredited LHD’s; and Recognize accreditation evidence used by PHAB accredited LHD’s that is appropriate in meeting DHS 140 required documentation requests.

DHS 140 – PHAB Crosswalk Wisconsin Statutes and Rules used in the DHS 140 Review PHAB Domains and Standards To identify: Evidence requested by both PHAB accreditation and the DHS 140 Review. Evidence requested by the DHS 140 Review only. The PHAB Domain most closely related to each statute and rule reference.

DHS 140 – PHAB Crosswalk DHS 140 Review Statutes, Rules and Evidence PHAB Domains, Standards, Measures and Evidence

DHS 140 – PHAB Crosswalk The Evidence

2014 – DHS 140 Review Tool Based on 2009 DHS 140 Review Tool. Combines more Statute and Rule references. More evidence available from DPH electronic documentation systems. Arranged by Essential Public Health Service. Identifies statute and rule references addressed by PHAB accreditation. Provides method for PHAB accredited agencies to address about one-third of evidence requests through submission of their PHAB accreditation report.

DHS 140 Review – Getting Started Two to three months prior to DHS 140 Process: DHS 140 letter to HO explaining the DHS 140 Review process. Link to the review tool(s). Proposed timeline for evidence submission to be completed . Proposed date of on-site review. LHD DHS 140 Review Team Recommendations shared with DPH Bureau Directors and staff assigned for DHS 140 review. DHS 140 Review Team convened. Bureau-specific evidence identified in the DHS 140 Review Tool.

DHS 140 Review – Documentation Submission LHD’s compile required documentation and submit the documentation as requested. The DHS 140 Review Team assigned to the LHD will review required documentation within two weeks of notification that documentation submission is complete. DHS 140 Review Team submits any questions regarding the required documentation back to the LHD. The LHD will respond to DHS 140 Review Team questions about documentation submitted within two weeks.

140 Review – Documentation Submission - PHAB Accredited For PHAB accredited agencies: Indicate on DHS 140 Review Tool if evidence for PHAB accreditation submitted met the PHAB evidence requirement. Submit PHAB accreditation report. If evidence used for PHAB accreditation does not correspond to DHS 140 required documentation requested, make requested documentation of meeting statute reference available.

DHS 140 Review – Documentation Submission Evidence types: Do not submit any electronic evidence containing patient confidential information! Web Links: links to documents available on agency or partner websites, e.g. community health assessment, community health improvement plan, annual report, minutes, newsletters, etc.) Electronic documents: load electronic documents on the DHS 140 SharePoint site. Hard copy documents: collect documents that cannot be sent electronically to be viewed during the on-site visit.

DHS 140 Level II and Level III Survey Review

DHS 140 Level II and Level III Survey Review Level II and Level III DHS 140 Review Surveys include: Level II and Level III Health Officer education and experience. Provision of public health programs and services: Level II: seven programs that meet at least five Healthiest Wisconsin 2020 health priorities. Level III: fourteen programs that meet at least seven Healthiest Wisconsin 2020 health priorities. Level III health departments provide the date of their most recent contract with the Division of Public Health for licensing and inspecting food, lodging and recreational facilities.

DHS 140 – On-Site Review DHS 140 Review Team visits the LHD to: Clarify evidence submitted. Review and hard copy documentation and complete review. Support the health department’s provision of public health services. DHS 140 Review Team determines if the LHD has met statutory requirements. If met, a DPH letter of designation is sent to the LHD, Board of Health Chair, and County Board Chair or other designated representatives; and a local presentation of the leveling certificate is scheduled. If not met, a DPH letter specifying DHS 140 deficiencies and asking for plan of remediation is sent.

Timeline

Timeline

DHS 140 Reviews Due New Local Health Officer Orientation Participants DHS 140 Review completed in 2009 DHS 140 Review completed after 2009 Burnett Douglas Eau Claire Madison/Dane De Pere Shawano-Menominee Marquette St. Croix Portage Lafayette Outagamie Walworth Waukesha

140 Reviews and Impact on You Agencies with new Health Officers have previously completed 140 reviews. Same documentation required. Same forms required. Face-to-face (LHD/DPH) meeting conducted. Board of Health members invited to participate.

What’s Happening Next with the DHS 140 Reviews November –December 2013 January – March 2014 Pilot Tests SharePoint site development Finalize DHS 140 Review Process Training DPH staff LHD Orientation BOH education DHS 140 Reviews expected to begin in earnest the second quarter of 2014

Benefits of the DHS 140 Review DHS 140 reviews are completed because: Per Wisconsin Statute 250, the Department of Health Services (DHS) requires evaluation of each health department in the state every five years to assure a basic level of services for all citizens. DHS 140 review process provides LHDs an opportunity: To review policies and procedures. To reorganize resource materials and update agreements. For staff and board members to learn from each other about the function and success of the local health department.

Example of 2009 Certificate of Designation that will be updated for 2014

Questions?